Analysis Of Related Factors Affecting The Operation Time Of SEST+EPBD Combined With EML In The Treatment Of Large Common Bile Duct Stones

Objective:Through analysis the cases of sEST+EPBD combined with EML in the treatment of large common bile duct stones,the factors affecting the operation time were discussed,and the related factors affecting the occurrence of post-ERCP pancreatitis were analyzed,so as to providing a basis for clinical treatment.Methods:Collecting the cases of ERCP stones removal treatment in the Gastrointestinal Endoscopy Room of the Second Affiliated Hospital of Kunming Medical University from January,2017 to December,2019.74 cases of stone with diameter≥15mm and all used sEST+EPBD combined with EML were selected.According to the operation time,group A was≤60 minutes(n=41),group B was>60minutes(n=33).Then according to whether post-ERCP pancreatitis occurred.Collecting patients’ preoperative data(age,gender,history of underlying diseases,preoperative serum total bilirubin),intraoperative data(distal common bile duce diameter,stone size,number of stones,nipple condition,Jutapapillary duodenal diverticulum,whether the guide wire enters the pancreatic duct,the size of the EST,the size of balloon expansion),postoperative data(number of successful stone cases,total hospitalization costs,hospital stay,postoperative complications,blood cells counting after surgery,total radiation dose of surgery).The differences between the groups were compared,and the two-class multivariate logistic regression analysis was used to analyze the related factors that affect the operation time and postoperative pancreatitis.Results:1.In the comparison of preoperative data,there were more patients whom≥60 years old in the group B than in the group A,and the difference was statistically significant(91%vs44%,p<0.0001).There were no statistically significant differences in gender,preoperative serum total bilirubin,and underlying diseases.2.In the comparison of intraoperative data,there were more patients in the group B with stone diameter/distal common bile duct diameter>1 than in the group A,and the difference was statistically significant(88%vs54%,p=0.002).There were more patients with Jutapapillary duodenal diverticulum in the group B than in the group A,and the difference was statistically significant(61%vs32%,p=0.013).There were no statistically significant differences in the diameter of the distal common bile duct,stone size,stone size distribution,stone number distribution,nipple stenosis,whether the guide wire entered the pancreatic duct,and the size of balloon dilation.3.The overall first-time stone removal rate was 85%,the overall stone removal rate was 100%.In the comparison between the postoperative data groups,the success rate of first-time stone retrieval in the group B was lower than that in the group A,and difference was statistically significant(76%vs93%,p=0.042).The average length of stay in the group B was longer than that in the group A,and the difference was statistically significant[(16.73±6.63)天 vs(13.51±4.13)天,p=0.043].The group B had more patients with postoperative abdominal pain than the group A,the difference was statistically significant(45%vs22%,p=0.032).There were more patients with elevated white blood cell after surgery in the group B than in the group A,and the difference was statistically significant(33%vs12%,p=0.028).The average total surgical radiation dose of the group B was more than that of the group A,and the difference was statistically significant[(36.26±17.25)mGy vs.(23.30±28.40)mGy,p=0.008],there was no difference in total complication between the two groups in the first postoperative period.4.In the comparison between the two groups of post-ERCP pancreatitis.The operation time of the post-ERCP pancreatitis group was longer than that of the non-occurring group,and the difference was statistically significant[(84.86±23.14)vs(52.00±27.00),p=0.004].There were more female patients in the post-ERCP pancreatitis group than in the non-occurring group,and the difference was statistically significant(86%vs36%,p=0.016).There were more cases of guide wire entering the pancreatic duct in the post-ERCP pancreatitis group than in the non-occurring group,and the difference was statistically significant(71%vs 19%,p=0.008).5.Multivariate logistic regression analysis of operation time indicated that the risk factors for operation time>60minutes were stone diameter/distal common bile duct diameter>1(p=0.010,OR=6.377,95%CI:1.566-25.975).and the presence of Jutapapillary duodenal diverticulum(p=0.043,OR=3.401,95%CI:1.042-11.104),elderly patients≥60 years old(p=0.001,OR=10.228,95%CI:2.463-42.475).6.Multivariate logistic regression analysis of post-ERCP pancreatitis indicated that the risk factors was operation time(min)(p=0.008,OR=1.058,95%CI:1.015-1.104),female patients(p=0.046,OR=32.214,95%CI:0.060-978.668),the guide wire entering the pancreatic duct during intubation(p=0.045,OR=9.124,95%CI:1.046-79.621).Conclusions:1.sEST+EPBD combined with EML is safe and effective for the treatment of large common bile duct stones(≥15mm).2.When using sEST+EPBD combined with EML to treat large common bile duct stones,the risk factors for operation time>60minutes are stone diameter/distal common bile duct diameter>1,the presence of duodenal papillary diverticulum,elderly patients≥60 years old.3.When using sEST+EPBD combined with EML to treat large common bile duct stones,the risk factors post-ERCP pancreatitis are excessive operation time,female patients,the guide wire entering the pancreatic duct during intubation.